Surgical tool introducer

ABSTRACT

A tool introducer is configured for introduction in an elongated body including a straight tube, wherein the tube encloses a tube lumen opened at its distal end with a tube opening. The tool introducer includes locking means to selectively lock or unlock an interchangeable surgical tool to the tube from displacing axially and/or rotationally in the tube lumen, the locking means being configured such that, at the locking, a tool connector of the tool projects towards the tube opening and is distanced therefrom by at least 3 cm. A method includes positioning the surgical tool introducer such that a distal portion thereof projects in a body cavity, manipulating and/or extending the tool introducer to reach and engage an elongated shaft introduced percutaneously into the body cavity; and inserting the elongated shaft into the tube lumen via the tube opening and connecting the tool to the elongated shaft.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional patent application of U.S. patentapplication Ser. No. 14/188,095, filed on Apr. 24, 2014, which claimspriority to U.S. Provisional Patent Application No. 61/768,846, filedFeb. 25, 2013, the disclosures of which are incorporated by reference intheir entirety.

FIELD OF THE INVENTION

The present invention generally relates to systems and methods forsurgeries preparations, and more specifically to methods and devices forassembling laparoscopic surgical instrumentation in a patient's bodycavity.

BACKGROUND OF THE INVENTION

In laparoscopic surgery, several relatively small ports are made in theabdomen for allowing introduction of different types of instrumentationand accessories into the abdominal cavity for different surgicalinterventions (usually performed under endoscopic vision). Althoughusually considered superior in several aspects to open surgery, the useof a plurality of 5 to 15 mm ports still leads to local pain, scars, andpossibly port related complications such as hernia in scars and the needfor one or two assistants in addition to the surgeon. A known conceptwhich aims at relieving some of such disadvantages includes the use of asingle port for introducing regular sized surgical heads which areinterchangeably connectable to manipulators extendable into theabdominal cavity via small sized entry points, usually 3 mm or less. Themanipulators usually includes an elongated slender shaft being 3 mm orless in diameter, emerging from a robotic or handheld actuator partprovided outside patient body, and they are introduced into theabdominal cavity either percutaneous (if having sharp distal end, forexample) or through a minimal invasive laparoscopic port. Priorpublications describing relevant techniques and instrumentation include:U.S. Pat. Nos. 5,352,219, 5,441,059, 5,593,402, 6,723,043, 7,666,181 and8,133,254.

Nevertheless, assembling any two parts projecting from remote entrypoints in a body cavity still possesses certain challenges that shouldbe answered in further improvement of currently proposed means andmethods. One challenge is to safely engage and then assemble these twoparts, even under laparoscopic vision, without possibly harming nearbytissues and organs and of course without dropping any of these partsbefore or during engagement and/or assembly in the body cavity. Secondchallenge is to locate, engage and assemble the two parts easily andrapidly so that no significant burden will be added to surgeon's work.

SUMMARY OF THE INVENTION

The present invention generally relates to systems and methods forsurgeries preparations, and more specifically to methods and devices forassembling and/or disassembling laparoscopic surgical instrumentation ina patient's body cavity.

In an aspect of some embodiments, there is provided a tool introducerwhich comprises or is configured for introduction in an elongated bodycomprising a tubular body, for example a straight tube. In someembodiments, the tube encloses a tube lumen opened at its distal endwith a tube opening. Optionally, the tube is sized and shaped forintroducing in a body cavity via a laparoscopic port. In someembodiments, the tube is extendable through and from the laparoscopicport by at least 5 cm, optionally by at least 10 cm, optionally by atleast 15 cm, optionally by at least 20 cm, or higher, or lower, or byany intermediate value.

Optionally, the elongated body includes an enlarged portion sized and/orshaped for barricading by the laparoscopic port. In some embodiments, aseal member is provided in or proximal to the lumen for sealing gas flowtherefrom from a distal environment (such as the body cavity) to aproximal environment (such as an outer environment to the body cavity).

In some embodiments, the tool introducer includes locking meansconfigured to selectively lock or unlock an interchangeable surgicaltool to the tube from displacing axially and/or rotationally in the tubelumen. Optionally, the locking means are configured such that, atlocking, a tool connector of the tool projects towards the tube openingand distanced therefrom by at least 3 cm, optionally by at least 5 cm,optionally by at least 10 cm, optionally by at least 20 cm, or higher,or lower, or any intermediate value. Optionally, the locking means areselectively introducible in the lumen, optionally as part of a plugmember, and fixedly connectable to the tube. The locking means mayinclude at least two opposing teeth selectively movable from an inwardposition when at locking to an outward position when at unlocking.Optionally, the locking means are normally locking. Optionally, thelocking means are manually operational with a button provided at oradjacent the enlarged portion.

In some embodiments, the tool introducer includes visualization means orallows introduction of such via the lumen. Optionally and additionally,the tool introducer includes lighting means or allows introduction ofsuch via the lumen.

In some embodiments, the tool is connectable with the tool connector toa fitting portion of a tool manipulator. Optionally, the fitting portionis located at a distal end of an elongated shaft. In some embodiments,the elongated shaft has a maximal diameter equal or smaller than 3 mm,optionally equal or smaller than 2 mm. In some embodiments, the toolmanipulator and/or elongated shaft are introducible into the body cavityvia an entry point remote to tool introducer entry. Optionally, theentry point is maintained by a second laparoscopic port or is made bypercutaneous progression of the elongated shaft through a body cavitywall enclosing the body cavity.

In an aspect of some embodiments, there is provided a method, comprisingat least one of the following steps (not necessarily in same order):

positioning a surgical tool introducer such that a distal portionthereof projects in a body cavity. Optionally, the tool introducercomprises or is being introduced into a straight tube, such as anengager or trocar, enclosing a tube lumen opened at its distal end witha tube opening. Optionally, the tool introducer includes locking meansprovided in the tube lumen to selectively lock or unlock aninterchangeable surgical tool to the tube from displacing axially and/orrotationally. Optionally, the tool includes a tool connector projectingtowards the tube opening and distanced therefrom by at least 3 cm.Optionally, the tool introducer positioning includes telescopicintroduction through a laparoscopic port;

penetrating, either percutaneously, or through a trocar, with anelongated shaft of a tool manipulator in the body cavity via an entrypoint remote to the tool introducer. In some embodiments, the elongatedshaft includes a fitting portion connectable with the tool connector ofthe tool. Optionally, the elongated shaft is sized and shaped to advancein the tube lumen at least until an adjoining of the fitting portion andthe tool connector is applicable;

manipulating and/or extending the tool introducer to reach and engagethe elongated shaft;

inserting the elongated shaft in the tube lumen via the tube opening;

advancing the elongated shaft in the tube lumen so that the elongatedshaft and tool substantially aligns. Optionally, the fitting portion isalso positioned in direct contact with the tool connector. In someembodiments, the advancing is preceded by positioning an interchangeablesurgical tool in the tube lumen such that the tool connector projectstowards the tube opening and distanced therefrom by at least 3 cm;

connecting the tool to the elongated shaft, optionally by adjoining thetool connector and the fitting portion; and

withdrawing the elongated shaft from the tube lumen, optionallyfollowing unlocking the tool.

In some embodiments, the step of manipulating and/or the step ofextending is preceded by at least one of introducing visualization meansin the tube lumen and applying the visualization means to locate theelongated shaft in the body cavity. In some embodiments, thevisualization means are removed before performing the positioning.

Optionally, at least one of the manipulating, extending and inserting isvisually monitored.

In some embodiments, the method also includes removing of the tool.Optionally the tool removal includes at least one of the followingsteps:

re-inserting the elongated shaft in the tube lumen via the tube opening;

re-advancing the elongated shaft with the tool in the tube lumen so thatthe elongated shaft and tool substantially aligns and optionally becomesin contact with the locking means;

disconnecting the tool from the elongated shaft by dispatching the toolconnector and the fitting portion. Optionally, disconnecting is precededby shifting the locking means to unlocking mode. Optionally, theunlocking is followed by returning the locking means to locked mode andlocking the tool to the tube; and

withdrawing the elongated shaft from the tube lumen.

In an aspect of some embodiments, there is provided a system whichincludes an elongated tube, comprising a tube proximal opening, a tubedistal opening, a tube lumen extending between the tube proximal openingand the tube distal opening. In some embodiments, the elongated tube hasa proximal segment and distal segment, and optionally the proximalsegment has a larger outer diameter than the distal segment. Optionally,a seal provided in the the lumen, optionally a zero seal and/or aninstruments seal. In some embodiments, the system also includes a toolholder which includes locking means to selectively lock or unlock aninterchangeable surgical tool from displacing axially and/orrotationally in the tube lumen. In some embodiments, the elongated tubeis telescopically introducible at a port proximal end, through a portlumen and bypassing a seal mechanism of a laparoscopic portinterconnecting a body cavity and an outer environment. In someembodiments, the tool holder is adapted to be inserted through the tubeproximal opening to be deployed in the tube lumen and thereby projectinga tool connector of the tool towards the tube distal opening and in adistance of at least 3 cm therefrom.

In some embodiments, the tool holder comprises a holder distal opening,a sealed proximal end and a holder lumen extending at least partiallytherebetween.

In some embodiments, the holder lumen is adapted to receive an endportion of a needle system when the needle entering the tube distalopening via the port distal opening.

BRIEF DESCRIPTION OF THE DRAWINGS

Some embodiments of the invention are herein described, by way ofexample only, with reference to the accompanying drawings. With specificreference now to the drawings in detail, it is stressed that theparticulars shown are by way of example and for purposes of illustrativediscussion of embodiments of the invention. In this regard, thedescription taken with the drawings makes apparent to those skilled inthe art how embodiments of the invention may be practiced.

In the drawings:

FIG. 1 schematically illustrates a cut view representing a toolintroducer, in accordance with an exemplary embodiment of the presentinvention;

FIGS. 2A-D schematically illustrate cut views representing differentstages of deploying a laparoscopic surgical tool, in accordance with anexemplary embodiment of the present invention;

FIGS. 3A-B schematically illustrate cut views representing use of anexemplary tool introducer for aligning between a surgical head and amanipulator distal end in a safe environment, in accordance with anexemplary embodiment of the present invention;

FIGS. 4A-B schematically illustrate cut views representing two exemplarytool introducers with different visualization means, in accordance withan exemplary embodiment of the present invention;

FIG. 5 schematically illustrates a cut view representing an exemplarysystem for introducing a surgical tool in a body cavity via alaparoscopic port and for engaging with, aligning and assemble thesurgical tool to a tool manipulator in the body cavity, in accordancewith an exemplary embodiment of the present invention;

FIG. 6 schematically illustrates a cut view representing an exemplarytool holder member of the exemplary system represented in FIG. 5, inaccordance with an exemplary embodiment of the present invention;

FIGS. 7A-K schematically illustrate cut views representing differentstages of deploying a laparoscopic surgical tool using the exemplarysystem represented in FIG. 5, in accordance with an exemplary embodimentof the present invention;

FIG. 8 schematically illustrates a cut view representing a toolintroducer introducible in a laparoscopic port, in accordance with anexemplary embodiment of the present invention; and

FIG. 9 schematically illustrates a cut view representing a toolintroducer with powered tool deployer, in accordance with an exemplaryembodiment of the present invention.

DETAILED DESCRIPTION

The present invention generally relates to systems and methods forsurgeries preparations, and more specifically to methods and devices forassembling laparoscopic surgical instrumentation in a patient's bodycavity.

In an aspect of some embodiments, there is provided a device or a “toolintroducer” for introducing surgical tools into a patient's body cavity,such as an abdominal cavity. Surgical tools according to presentdisclosure may include any surgical tool known to art having outerdiameter generally being equal or smaller than 20 mm, or equal orsmaller than 10 mm, or in some exemplary embodiments being substantiallybetween 3 mm to 5 mm in outer diameter. As such, surgical toolsaccording to present disclosure may include but not be limited tograspers, coagulators, hooks, staplers, scalpels, suturing means, heator light sources, surgical monitoring devices, scissors, needle holders,retractors, clip applicators or others. In some embodiments, surgicaltools according to present disclosure are surgical heads connectable tomanipulators, which may be either manually or robotically operable. Insome embodiments, surgical heads according to present disclosure areinterchangeable in the sense that different surgical heads can beconnected, sequentially, onto a single manipulator. Manipulatorsaccording to present disclosure generally include an elongated shaft,optionally needle like, with means to connect to and actuate thesurgical head. Connection between surgical head and elongated shaft mayinclude any type of connection means such as but not limited to snaplocking, elastic teeth, threading, bayonet locking, clamp/chuckconnection, ball and socket, magnet, friction, expandable portion (e.g.,balloon member), or others. In some embodiments, such elongated shaftsare generally 5 mm or less in diameter, optionally 3 mm or less,optionally 2 mm or less, or higher, or lower, or in any intermediatevalue.

In some embodiments, the tool introducer includes or is introducible inan elongated sleeve or tubular member (optionally, though notnecessarily, cylindrical) in which the elongated shaft may be insertedfor assembling or disassembling with the surgical heads positionable andlockable therein. In some embodiments, surgical tool docking and/orlocking position in the tool introducer is distant enough from itsdistal opening therefore forcing the elongated shaft of the manipulatorto align at least partially so that easier assembling condition is met.In some such embodiments, distance from distal opening may be at least 3cm, optionally at least 5 cm, optionally at least 10 cm, optionally atleast 20 cm. In some embodiments, assembling or disassembling ispossible in the body cavity, optionally and alternatively outsidepatients body, or optionally anywhere in between.

Reference is made to FIG. 1 which schematically illustrates a cut viewrepresenting a tool introducer 100, in accordance with an exemplaryembodiment of the present invention. Tool introducer 100 includes anelongated body comprising a straight tube 110, the tube enclosing a tubelumen 160 opened at its distal end with a tube opening 130. Toolintroducer 100 also includes locking means 170 which are provided intube lumen 160 to selectively lock or unlock an interchangeable surgicaltool 200 to tube 110 from displacing axially and/or rotationally.

In some embodiments, the locking means are configured such that, atlocking, a tool connector 210 of the tool 200 projects towards tubeopening 130 and distanced with a distance d1 therefrom being at least 3cm, or optionally by at least 5 cm, or optionally by at least 10 cm, oroptionally by at least 20 cm, or higher, or lower, or any intermediatevalue.

Tool introducer 100 includes a seal member 150 provided in or proximalto lumen 160 for sealing gas flow therefrom from a distal environment toa proximal environment, so, for example, inflation gas (normally CO2)will not escape abdominal cavity during tool introduction and/orassembly/disassembly. Seal member 150 may be permanent or selectivelyremovable, may be firm or pliable (e.g., a valve) or have any form asknown in the art. Tool 200 may be readily provided in lumen 160 or canbe introducible thereto via tube's proximal opening 140, optionally withor without locking means 170.

Tool introducer 100 may be deliverable into the body cavity via apremade cut or puncture, or it may be introduced in a percutaneousfashion while penetrating and piercing through tissues from the outerenvironment and into the inner environment enclosed in the body cavity.Optionally and alternatively, tool introducer 100 is introducible via alaparoscopic port so, optionally, tube 110 is sized and shaped forintroducing in a body cavity via a laparoscopic port. In someembodiments, and as shown in FIG. 1, tool introducer 100 includes anenlarged portion 120 sized and/or shaped for barricading by alaparoscopic port.

Reference is now made to FIGS. 2A-D which schematically illustrate cutviews representing different stages of deploying surgical tool 200, inaccordance with an exemplary embodiment of the present invention. In thesuggested method, tool 200 is introduced from outer environment OE intobody cavity BC through body cavity wall CW so that it can be connectedwhile in body cavity BC to a distal end portion 315 of a manipulator300. As shown in FIG. 2A, a laparoscopic port 400 is provided in bodycavity wall CW, through a first entry point E1, thereby creating aselectively sealed passage between body cavity BC and an outerenvironment OE. Laparoscopic port 400 may be of any type known to art, atrocar, a sheath or other, with means to connect to a gas pressurizingsource and to seal gas backflow therethrough. In some embodiments,laparoscopic port 400 allows passing therethrough of objects (such astools and instruments) that if aligned with its elongated axis hasexternal boundaries of about 20 mm or less in diameter, or optionallyabout 10 mm or less in diameter or optionally about 5 mm or less indiameter. In some embodiments, laparoscopic port 400 is the largestlaparoscopic port provided in cavity wall CW during surgery to introducelarge or normal size surgical tools in body cavity BC. Optionally andalternatively, laparoscopic port 400 is the single laparoscopic portused during surgery hence other means (e.g., manipulators) may beintroduced in body cavity BC otherwise, such as by percutaneouspenetration through cavity wall CW. In some embodiments, if body cavityBC is an abdominal cavity, first entry point E1 may be the umbilicus.Laparoscopic port 400 introduction and setting may be done as commonlypracticed in laparoscopic surgery.

Before, after or in parallel to providing laparoscopic port 400 in firstentry point E1, tool manipulator 300 is introduced as well and deployedin body cavity BC. Tool manipulator 300 includes an elongated shaft 310ending distally with end portion 315 and with a proximal handheld part320 having at least one actuating member 325. Elongated shaft 310penetrates into body cavity BC through a second entry point E2, beingsubstantially remote to first entry point E1. In some embodiments, endportion 315 is sharp such that it can be used to pierce through apercutaneous passage through body cavity wall CW at second entry pointE2. Elongated shaft 310 comprises a fitting portion (not shown)connectable with a tool connector of a surgical tool (such as toolconnector 210 of tool 200). Elongated shaft 310 is sized and shaped suchso it can be advanced in a tube lumen (such as lumen 160 of toolintroducer 100), at least until an adjoining fitting portion and toolconnector is applicable.

As shown in FIG. 2A, tool introducer 100 equipped with tool 200 ispassed via laparoscopic port 400 such that tube 110 projects in bodycavity BC and tube opening 130 is opened to body cavity BC. Before,during or after such passing of tool introducer 100 through laparoscopicport 400, visualization means (not shown) can be used in order to traceelongated shaft 310 and/or its distal end 315. Such visualization meansmay include any of a laparoscope, endoscope, optical fiber, and acamera, optionally accompanied with illumination means, and these may beprovided as an integral part of tool introducer 100 or laparoscopic port400, or can be inserted as a separate device via tool introducer 100 orlaparoscopic port 400. Tool introducer 100 is then manipulated and/orextended, under vision or blindly, in order to reach and engageelongated shaft 310 and/or its distal end 315. In some embodiments, tube110 is extendable through and from laparoscopic port 400 by at least 5cm, optionally by at least 10 cm, optionally by at least 15 cm,optionally by at least 20 cm. Optionally and alternatively (not shown),the visualization means are introduced from a separate entry point intobody cavity BC and can be used to survey engagement and connection ofthe system components as described below, from the side.

As shown in FIG. 2C, elongated shaft 310 is inserted in tube lumen 160via tube opening 130 and then advanced therein so that elongated shaft310 and tool 200 substantially aligns, optionally forced to align bybounded geometries of elongated shaft 310 in tube 110. Elongated shaftis advanced until assembly with tool 200 is possible, optionally whenthe fitting portion of elongated shaft 310 is in direct contact withtool connector 210. Tool 200 may then be connected to elongated shaft310 by adjoining tool connector and fitting portion. As shown in FIG.2D, manipulator 300 may then be withdrawn so that elongated shaft 310 isremoved from tube lumen 160, and the assembled surgical instrument canbe applied for surgery as needed. Optionally, tool 200 is first unlockedfrom tool introducer 100 before manipulator 300 can be withdrawn. Toolintroducer 100 may be kept in laparoscopic port 400 or removed therefrom(as shown), optionally replaced with a second tool introducer equippedwith another tool for connecting to a second manipulator (not shown).

Reference is made to FIGS. 3A-B which schematically illustrate cut viewsrepresenting use of an exemplary tool introducer 1100 in a laparoscopicsystem 1000 for aligning between a surgical head 1200 and a manipulatordistal end 1300 in a safe environment, in accordance with an exemplaryembodiment of the present invention. Tool introducer 1100 includes anelongated tubular body 1110 having an enlarged portion 1120 ending witha sealed proximal end 1140, and a distal end 1130 opened to inner lumen1160. In lumen 1160 with distance d2 from distal opening 1130 there is adocking portion 1150 which selectively locks to surgical head 1200 shownnests therein. Docking portion 1150 opens distally with an angle α forallowing centering of incoming slender artifacts sliding therein untilreaching and arriving in direct contact with connector 1210 of surgicalhead 1200. Manipulator 1300 includes an inner member 1320 and an outermember 1310 which may be fixed or rotatable and/or slidable on with theother. At least inner member 1320 includes a fitting portion at itsdistal tip, namely thread 1325 that can be threaded in connector 1210having mating thread for bolt-and-nut type connection. Distance d2 ischosen such to achieve a maximally allowed angle of attack β when thread1325 is adjacent docking portion 1150 entry, in order to assist inaccurate positioning therein. In some embodiments, angle β is equal orsmaller than about 45°, optionally equal or smaller than about 30°,optionally equal or smaller than about 15°, optionally equal or smallerthan about 5°, or higher, or lower, or of any intermediate value. Insome such embodiments, angle β depends on distance d2 as well as ingeometrical ratios between lumen 1160 size and manipulator outerboundaries dimensions. In some embodiments, distance d2 is at least 3cm, optionally at least 5 cm, optionally at least 10 cm. In someembodiments, lumen 1160 diameter distal to docking portion 1150 isbetween 10 mm and 1 mm, optionally between 7 mm and 2 mm, optionallybetween 5 mm and 3 mm. In some embodiments, outer diameter ofmanipulator distal end 1300 is equal to or smaller than about 3 mm,optionally equal to or smaller than 2 mm, optionally about 1.5 mm.

As shown in FIG. 3A, manipulator distal end 1300 advances in lumen 1160and reaches docking portion 1150. Lumen boundaries imposed by tubularbody 1110 are rigid yet smooth enough so that manipulator 1300 would notstuck or cling in-place, while providing a tracked passage thereinsidewhile preventing possible harm to organs or tissues outside tubular body1110 which may potentially happen in case the surgeon would targetmanipulator distal end 1300 directly to a small opening such as ofsurgical head connector 1210. After manipulator distal end 1300 isadvanced in lumen 1160 and forced to align thereto, connection withsurgical head 1200 can then be made, as shown in FIG. 3B. In someembodiments, entire manipulator end portion 1300 or only inner member1320 revolves so that thread 1325 threads into connector 1210.

FIGS. 4A-B schematically illustrate cut views representing two exemplarytool introducers 1400 and 1500 with different visualization means, inaccordance with an exemplary embodiment of the present invention. Asshown in FIG. 4A, tool introducer 1400 includes an elongated tubularbody 1410 having an enlarged portion 1420 ending with a sealed proximalend 1440, and a distal end 1430 opened to inner lumen 1460. A dockingportion 1450 is provided in lumen 1460 which can selectively lock to asurgical head (not shown). Tubular body 1410 at its distal end aroundopening 1460 encloses at least one visual capture device 1470 (e.g.,digital camera head) and at least one illumination source 1480 (e.g.,LED illumination) which may be operational wired or wirelessly to powersource and/or image recording unit provided outside patient's body. Asshown in FIG. 4B, tool introducer 1500 includes an elongated tubularbody 1510 having an enlarged portion 1520 ending with a selectivelysealed proximal end 1540, housing a valve 1570, and a distal end 1530opened to inner lumen 1560. A docking portion 1550 is provided in lumen1560 which can selectively lock to a surgical head (not shown). Anoptical fiber 1600 is shown when introduced through lumen 1560 that isconfigured to transfer image and light from its tip 1610 backwards toimage capture and recording means (not shown) provided outside patient'sbody.

In some embodiments, a tool introducer is provided as a system or a kitwhich comprises an elongated tubular member (tube) or sleeve forreaching and engaging a distal end of a tool manipulator, and a separatedrawer and/or tool locking means that can be inserted from a proximalopening of the tube and deliver a tool therein to a predefined positionhaving a minimal distance from tube's proximal opening, as previouslydescribed. As such, systems or kits according to the present disclosuremay include locking means that are selectively introducible in tube'slumen, optionally as part of a plug member, and fixedly connectable tothe tube. In some such embodiments, locking means may include at leasttwo opposing teeth selectively movable from an inward position atlocking to an outward position at unlocking. Optionally, the lockingmeans are normally locking. Optionally, the locking means are manuallyoperational with a button mechanism. Optionally, the tube is sized andconfigured for passing through a laparoscopic port, such as acommercially available laparoscopic port having inner diameter between 3mm and 20 mm, or optionally between 5 mm and 10 mm.

Reference is now made to FIG. 5 which schematically illustrates a cutview representing an exemplary system 2000 for introducing a surgicaltool in a body cavity via a laparoscopic port 2100 and for engagingwith, aligning and assemble the surgical tool to a tool manipulator (notshown) in the body cavity, in accordance with an exemplary embodiment ofthe present invention. System 2000 includes an engager 2200 and a toolholder 2300. In FIG. 5, tool holder 2300 is shown equipped with aninterchangeable grasper 2400 and provided in and assembled to engager2200; and both are provided in and through laparoscopic port 2100.

System 2000 may be sold or provided to the surgical team as a kitcomprising at least one engager 2200 (shown in detail in FIG. 7B) and atleast one tool holder 2300 (shown in detail in FIG. 6). The kit may alsoinclude laparoscopic port 2100 (shown in detail in FIG. 7A) or beconfigured to work with commercially available ports. The kit may alsoinclude at least one surgical tool, optionally including but not limitedto interchangeable grasper 2400 (shown in detail in FIG. 7D). The kitmay also include at least one tool loader, optionally including but notlimited to a grasper loader 2600 (shown in detail in FIGS. 7D-E). Thekit may also include at least one manipulator comprising a needleportion, optionally including but not limited to needle 2700 (shown indetail in FIG. 71).

Laparoscopic port 2100 includes an elongated tubular member or tube 2110enclosing a lumen 2120 and having a proximal enlarged handheld portion2130. Handheld portion allows introduction of objects therethrough intobody cavities when deployed via proximal port opening 2140 and includesat least one seal such as port seal 2150 to prevent gas escape. Pressureinlet 2160 allows connection to a pressurized gas source. Laparoscopicsurgery involves insufflation of a gas (usually carbon dioxide) into theabdominal/peritoneal cavity producing a pneumoperitoneum. This causes anincrease in intra-abdominal pressure (IAP). Carbon dioxide is commonlyinsufflated into the peritoneal cavity for example at a rate of 4-6liter/min to a pressure of 10-20 mm Hg, for example. Thepneumoperitoneum may be maintained for example by a constant gas flow of200-400 ml/min.

Engager 2200 includes an elongated tubular body 2210 opened at aproximal end 2240 and at a distal end 2270 with a lumen 2220 extendingtherebetween. According to the present disclosure, elongated tube 2200includes at least one seal provided in lumen 2220 such as a zero seal2260 (configured to prevent gas passage at least when it is absent fromany object extending therethrough) and an instruments seal 2250(configured to prevent gas at least when objects having outer diameterof a certain diameter range extends therethrough). Optionally and asshown, at its distal end 2270 there is provided an expandable funnel,optionally and as shown, an asymmetrical funnel component 2212. In someembodiments, funnel 2212 is a self-expandable partially (or,alternatively, fully) conic structure, expandable from andre-collapsible to a substantially tubular form. At its tubular form,funnel 2212 can be passed at both directions through laparoscopic portlumen 2120. At its expanded conic form, funnel 2212 has a substantiallygreater span which increases covering area around any intruding slenderobjects, such as a distal end portion of a manipulator longitudinalshaft. Furthermore, the expanded funnel 2212 facilitates a more smootherintroduction and accommodation of a nonaligned shaft (e.g., projectingat an angle between 100-180° of any coordinate axis with respect toengager tube's longitudinal axis) so that instead of impinging and evenpenetrating through the funnel, the needle can gently slide over thecurved walls of the funnel until aligning with its longitudinal axis.With its configuration, including a tapered edge and having a firstclosed side and a second substantially opened side, funnel 2212 allows acontinuous accurate visualization and monitoring using an endoscope or acamera projected forward. Such a design further allows a faster andeasier recollapsing of funnel 2212. As shown in FIG. 5 and in FIG. 7B,tube body 2210 is telescopically introducible at proximal end 2140 oflaparoscopic port 2100, through lumen 2120 and bypassing seal 2150, yetmaintaining sealed passage to gas passage therein (with seals 2250and/or 2260) or between its outer boundaries and seal 2150.

Tool holder 2300 includes an inner sleeve member 2320 slidable in anouter sleeve member 2310. Outer sleeve member 2310 has an enlargedproximal end portion 2312 with a concavity fitted for a push-button2330. Button 2330 is connected to proximal end of inner sleeve member2320 and is interconnected with compression spring 2332 to outer sleevemember 2310 so that is normally pulled back with respect to outer sleevemember 2310 when not pushed in. Tool holder 2300 includes locking means2326 to selectively lock or unlock an interchangeable surgical tool fromdisplacing axially and/or rotationally in engager tube lumen 2220. Insome embodiments and as shown, locking means 2326 include a distalportion of inner sleeve member 2320 that is slitted partially along itslength with slits 2324 so that to create a plurality of teeth 2322configured to extend outwardly from longitudinal axis when emerging outof outer sleeve member 2310 (when button 2330 is pushed). When button2330 is at backward position (pulled back) teeth 2322 are inwardlycompressed and nest within the boundaries imposed by outer sleeve member2310, so that in case an surgical tool is housed in tool holder 2300 (asshown for example in FIG. 7G) the inwardly compressed teeth locks thetool in-place. In some embodiments, and as shown in FIG. 5 and in FIG.7G, tool holder 2300 is adapted to be inserted through engager'sproximal opening 2240 to be deployed in lumen 2220 and therebyprojecting a tool connector (such as connection threads 2422 and 2424 ofinterchangeable grasper 2400) towards engager's distal opening 2270. Insome embodiments, a surgical tool, such as interchangeable grasper 2400,when placed with tool holder 2300 in and assembled with engager 2200,has its distal-most face distanced by at least 3 cm from distal end 2270of engager 2200.

Interchangeable grasper 2400 includes a grasper portion 2410 and aconnector portion 2420. Grasper portion 2410 includes a first jaw 2412and a second jaw 2414 pivotally connected with a joint 2416. Connectorportion 2420 includes an inner member comprising a first female thread2422 slidable in an outer member comprising a second female thread 2424,larger in diameter than first female thread 2422. Relative distancebetween threads 2422 and 2424 determine relative distance between jaws2412 and 2414 or magnitude of compression force developed therebetween.A compression spring 2426 keeps threads 2422 and 2424 in a nominaldistance such that jaws 2412 and 2414 are kept closed (in-contact) yetwith negligible compression.

Needle 2700 of manipulator (which is not shown in full) includes aninner rod member 2730 slidable in cylindrical member 2720. Inner rodmember 2730 has a distal dull tip 2734 and a first male thread 2732adjacent thereto. Cylindrical member 2720 includes a second male thread2722 provided at its distal end. In some embodiments, needle 2700 isoperable to create a percutaneous penetration path hence includes sharpmeans to puncture and cut through soft tissues. In some suchembodiments, and as shown, needle 2700 includes an outer cover 2710 withsharp distal end in which cylindrical member 2720 may slide backwardsalong with inner rod member 2730 until fully retracted therein, so thatneedle 2700 acts similarly to a veress needle as needed.

Reference is now made to FIGS. 7A-K which schematically illustrate cutviews representing different stages of deploying interchangeable grasper2400 using system 2000, in accordance with an exemplary embodiment ofthe present invention. As shown in FIG. 7A, laparoscopic port 2100 isintroduced into body cavity BC through body cavity wall CW using knownsurgical practiced techniques. Body cavity BC may then be insufflatedvia pressure inlet 2160. As shown in FIG. 7B, engager 2200 is thenpassed in laparoscopic port 2100 bypassing its seal 2150 yet keeping asealed environment using zero seal 2260. As shown in FIG. 7C, alaparoscope 2500 is introduced into body cavity BC via engager 2200 withits distal end 2510 peeping partially beneath and in funnel 2212, orupward or backward thereto. Laparoscope 2500 can be used to trace endportion of a manipulator (such as needle 2700 shown in FIGS. 7H-K) andvisualize approaching and reaching it with funnel 2212. Once manipulatoremerges into engager's lumen 2220, optionally while laparoscope 2500 ispartially withdrawn, the laparoscope can be removed and further stepscan optionally be made blindly.

Before, after or in parallel to the above-mentioned steps,interchangeable grasper 2400 may optionally be loaded in tool holder2300 (in case it is not preloaded) using loader 2600. As shown in FIG.7D, loader 2600 is bolted (optionally manually, using its enlarged endportion 2610) with a threaded portion 2620 into second female thread2424 of interchangeable grasper 2400. Alternatively and optionally,loader may be plugged in into a recess such as second female thread 2424of interchangeable grasper 2400 without threading. With loader 2600,interchangeable grasper 2400 is then pushed into tool introducer 2300while its button 2330 is pushed so that teeth 2322 extend out from outersleeve member 2310 and outwardly, so that to allow such loading (asshown in FIG. 7E) until interchangeable grasper 2400 is fully nestingin-position (as shown in FIG. 7F). Button 2330 may then be released topop out, and loader unbolted and removed.

Afterwards, the loaded tool introducer 2300 is inserted (e.g.,plugged-in or bolted) in engager 2200 via its proximal opening 2240,optionally instead of laparoscope 2500. Needle 2700 may then advanceforward in engager lumen 2210 until reaching distal portion ofinterchangeable grasper 2400 (FIG. 7H). Connection is made possible, forexample, if both inner rod member 2730 and cylindrical member 2720revolves (e.g., clockwise) until first male thread 2732 is bolted infirst female thread 2422 and second male thread 2734 is bolted in secondfemale thread 2424 (FIG. 7J). Only then, button 2330 can be pushed andneedle 2700, now equipped with interchangeable grasper 2400) can bewithdrawn from tool holder 2300 and engager 2200 and be used in surgeryas needed.

In some embodiments, different or similar tools can be loaded in same ordifferent tool holder, using same or different loader, so same ordifferent needles/manipulators. Tool holder 2300 can be removed andreplaced with laparoscope 2500 for visualizing the surgical procedure.

Disassembly of interchangeable grasper 2400 from needle 2700 (or ofother likewise instrumentation) can be done similarly in reversefashion, for example by first using engager 2200 equipped withlaparoscope 2500 to locate, reach and engage interchangeable grasper2400. Then inserting the interchangeable grasper partially in engager2200 and removing laparoscope 2500. Then inserting unloaded tool holder2300 in engager 2200 and pushing interchangeable grasper thereto untilcontacting teeth 2322. In some embodiments, verification of correctcontact is made (optionally, visually and/or tactilely and/orelectronically or otherwise). In some embodiments, the pushing ends withpreliminary locking such as by snap-locking means. Then, button 2330 ispushed and interchangeable grasper 2400 can be pushed further to nest intool introducer 2300 and allow proper release of button 2330.Afterwards, the needle 2700 can be unbolted from interchangeable grasper2400 and all instruments may be removed from patient's body or replacedas needed.

Reference is made to FIG. 8 which schematically illustrates a cut viewrepresenting a tool introducer 3100 introducible in a laparoscopic port3300, in accordance with an exemplary embodiment of the presentinvention. Laparoscopic port 3300 may be a commercially available deviceprovided with or separate to tool introducer 3100, from same ordifferent vendor. Laparoscopic port 3300 may be a sheath or cannula of alaparoscopic trocar system having standard or non-standard sizes, forexample an inner diameter of 5 mm, 8 mm, 11 mm, 12 mm or 15 mm, orhigher, or lower, or intermediate size, and/or a length of 50 mm, 75 mm,100 mm, 150 mm, 200 mm, or higher, or lower, or intermediate size.Laparoscopic port 3300 includes a hollow tubular body 3310 with aproximal wide portion 3320, a proximal end 3340 and a distal end 3330. Asealing mechanism 3350, commonly comprising zero seal and/or instrumentsseal, is configured for sealing inner passage of tubular body 3310 ifempty or if occupied with artifacts, such as tool introducer 3100,passing therethrough.

Tool introducer 3100 includes an elongated body 3110 and locking means3120 to selectively lock or unlock with an interchangeable surgical tool3200 from moving or displacing axially and/or rotationally. Toolintroducer 3100 also includes a handheld portion 3130 at its proximalend for manual actuation and/or maneuverability such as in and outlaparoscopic port 3300, and through it, in and out an internal bodycavity if laparoscopic port 3300 is deployed in the body cavity wall.Tool introducer 3100 may be configured, such as sized and/or shaped,such that it can place tool 3200 in a certain predetermined position inlaparoscopic port 3300 or at least in minimal distance to its distal end3330. In some such embodiments, handheld portion 3130 may be shapedand/or sized such as it can serve as a stopper for maximal projection oftool 3200 in tubular body 3310 inner passage.

In some embodiments, tool introducer 3100 is configured such that, atlocking, a tool connector 3220 of the tool 3200 projects towards tubeopening at distal end 3330 and distanced with a distance P there frombeing at least 3 cm, or optionally by at least 5 cm, or optionally by atleast 10 cm, or optionally by at least 20 cm, or higher, or lower, orany intermediate value.

Tool 3200 may be readily provided in locking means 3120 and it can beintroducible thereto via proximal opening at proximal end 3340 with toolintroducer 3100.

FIG. 9 schematically illustrates a cut view representing a toolintroducer 4100 with a powered tool deployer 4400, in accordance with anexemplary embodiment of the present invention. Tool introducer 4100 issimilar in many respects to tool introducer 3100 and is meant forintroduction in an elongated tubular member, such as laparoscopic port4300, and for positioning and/or locking a surgical tool such as tool4200 thereinside, to a predetermined distance from a distal openingthereof being at least 3 cm in length. Tool introducer 4100 includes anelongated body comprising of a distal member 4120 with locking meansadapted for selectively locking in tool 4200, which is rotationallyconnected with a hollow proximal member 4130 starting with a handheldportion 4110. At the intersection of distal member 4120 and proximalmember 4130 there is a recess 4140 configured for interaction with acorresponding projecting portion 4462 of powered tool deployer 4400,optionally having non-circular cross section, either symmetrical (suchas hexagonal cross section) or not symmetrical (such as a rectangularslit).

Powered tool deployer 4400 is configured to couple with tool introducer4100 (when, optionally, placed in laparoscopic port 4300) and rotatedistal member 4120 about proximal member 4130, thereby rotating tool4200, such that when a distal end of a tool manipulator elongated shaft,having a fitting portion configured to thread to corresponding portionin tool 4200, is pressed thereto, then tool 4200 will connect to thetool manipulator, and vice versa. Powered tool deployer 4400 includes anelongated portion 4410 sized to fit and extend in the hollow proximalmember 4130 of tool introducer 4100, and a proximal handheld part 4420containing the powering components, such as motor 4440, controller 4450and battery 4430. Alternatively and optionally, the powering element maybe a spring that is tensioned manually, and that may be released by anactuator to activate the tool deployer. Elongated portion 4410 houses adriver shaft 4460 ending with projecting portion 4462. Driver shaft 4460is connected to motor 4440 and controller 4450 is configured todetermine timing for powering motor 4440 to revolve diver shaft 4460and, optionally, other features (such as torque moment, velocity andothers). Battery 4430 is optionally rechargeable. Motor 4440 operationmay begin selectively upon operator's triggering (such as by pressing atrigger or a push button; not shown), or automatically, for example uponconnection of tool 4200 with a corresponding fitting portion of a toolmanipulator (not shown). Tool 4200 and manipulator fitting portion mayinclude specific identification and compatibility means such that motor4440 will not be ignited unless proper identification and/orcompatibility are met.

Although the invention has been described in conjunction with specificembodiments thereof, it is evident that many alternatives, modificationsand variations will be apparent to those skilled in the art.Accordingly, it is intended to embrace all such alternatives,modifications and variations that fall within the spirit and broad scopeof the appended claims.

All publications, patents and patent applications mentioned in thisspecification are herein incorporated in their entirety by referenceinto the specification, to the same extent as if each individualpublication, patent or patent application was specifically andindividually indicated to be incorporated herein by reference. Inaddition, citation or identification of any reference in thisapplication shall not be construed as an admission that such referenceis available as prior art to the present invention. To the extent thatsection headings are used, they should not be construed as necessarilylimiting.

What is claimed is:
 1. A tool introducer configured for introduction ofa surgical tool and connection of the surgical tool to an elongatedshaft of a tool manipulator, the tool introducer comprising: a straighttube having a tube proximal opening and a tube distal opening, thestraight tube enclosing a tube lumen, and the tube distal opening beingconfigured to receive the elongate shaft; and a docking portionconfigured to selectively lock or unlock the surgical tool to saidstraight tube from displacing axially and/or rotationally in said tubelumen, wherein said docking portion is configured such that, whenlocked, a tool connector of said surgical tool projects towards saidtube distal opening and is distanced proximally from said tube distalopening by at least 3 cm, and said docking portion includes an innersurface extending at an angle a relative to a longitudinal axis of saidstraight tube for centering and guiding the elongated shaft to said toolconnector to connect the tool connector.
 2. The tool introduceraccording to claim 1, wherein said straight tube is sized and shaped forbeing introduced in a body cavity via a laparoscopic port.
 3. The toolintroducer according to claim 2, wherein said tool introducer comprisesan enlarged portion sized and/or shaped for barricading by saidlaparoscopic port.
 4. The tool introducer according to claim 1, wherein,when locked, said tool connector is distanced from said distal openingby at least 5 cm.
 5. The tool introducer according to claim 1, furthercomprising visualization means.
 6. The tool introducer according toclaim 1, further comprising lighting means.
 7. The tool introduceraccording to claim 1, further comprising a seal member provided in orproximal to said lumen for sealing gas flow therefrom from a distalenvironment to a proximal environment.
 8. The tool introducer accordingto claim 2, wherein said straight tube is extendable through and fromsaid laparoscopic port by at least 15 cm.
 9. The tool introduceraccording to claim 1, wherein said docking portion is selectivelyintroducible in said lumen and fixedly connectable to said straighttube.
 10. The tool introducer according to claim 9, wherein said dockingportion comprises at least two opposing teeth selectively movable froman inward position at said locking to an outward position at saidunlocking.
 11. The tool introducer according to claim 1, wherein saiddocking portion is normally locking.
 12. The tool introducer accordingto claim 3, wherein said docking portion is manually operational with abutton provided at or adjacent said enlarged portion.
 13. The toolintroducer according to claim 1, wherein said surgical tool isconnectable with said tool connector to a fitting portion of a toolmanipulator, and said fitting portion is located at a distal end of anelongated shaft.
 14. The tool introducer according to claim 13, whereinsaid elongated shaft has a maximal diameter equal to or smaller than 3mm.
 15. The tool introducer according to claim 13, wherein said toolmanipulator and/or elongated shaft are introducible into a body cavityvia an entry point remote to tool introducer entry.
 16. The toolintroducer according to claim 15, wherein said entry point is maintainedby a second laparoscopic port.
 17. A system comprising: a surgical toolhaving a tool connector; an elongated tube comprising a tube proximalopening, a tube distal opening, a tube lumen extending between said tubeproximal opening and said tube distal opening, and a seal provided insaid tube lumen; and a tool holder configured to selectively lock orunlock the surgical tool from displacing axially and/or rotationally insaid tube lumen, wherein said tool holder is configured such that, whenlocked, the tool connector projects towards said tube distal opening andis distanced proximally from said tube distal opening by at least 3 cm,and said tool holder includes an inner surface extending at an angle arelative to a longitudinal axis of said elongated tube for centering andguiding an elongated shaft of a tool manipulator to said tool connectorof said surgical tool the tool connector, wherein said elongated tube istelescopically introducible at a port proximal end, through a port lumenand bypassing a seal mechanism of a laparoscopic port interconnecting abody cavity and an outer environment.
 18. The system according to claim17, wherein said tool holder comprises a holder distal opening, a sealedproximal end, and a holder lumen extending at least partiallytherebetween.
 19. The system according to claim 17, wherein saidelongated tube has a proximal segment and distal segment, and saidproximal segment has a larger outer diameter than said distal segment.20. The system according to claim 18, wherein said holder lumen isadapted to receive an end portion of a needle system when said needleentering said tube distal opening via a port distal opening.